title: Carbon dioxide laser-assisted endoscopic cricopharyngeal myotomy with primary mucosal closure.
abstract: OBJECTIVE
  Carbon dioxide laser-assisted endoscopic cricopharyngeal myotomy (ECPM) has emerged as a viable therapy for dysphagia. The risks of the procedure include pharyngoesophageal perforation and mediastinitis, which may discourage adoption of this technique. To address these complications, we examined outcomes of ECPM with primary mucosal closure.
  
  
  METHODS
  A case series of 7 patients who underwent ECPM between 2006 and 2008 were reviewed for length of operation, length of hospitalization, postoperative complications, and outcomes by use of the M. D. Anderson Dysphagia Index (MDADI) and the Functional Outcome Swallowing Scale (FOSS). The results were compared to those of a control group of 7 patients treated during the same period via open cricopharyngeal myotomy.
  
  
  RESULTS
  All patients who had ECPM were treated successfully without complications. The operative times averaged 128 minutes. The hospitalization averaged 2.1 days. Statistically significant improvements in swallowing were seen (MDADI score from 51.3 to 77.7, p < 0.0006; FOSS score from 3.7 to 1.3, p < 0.0005), and were similar to those in the patients who had the open procedure (FOSS score from 3.0 to 1.0, p <0.006). Trends toward decreased blood loss, a shorter hospital stay, and a lower complication rate were observed in the patients who had ECPM.
  
  
  CONCLUSIONS
  ECPM is beneficial as a primary treatment for cricopharyngeal dysfunction. Closure of the mucosal defect may help reduce the incidence of postoperative cervical emphysema and mediastinitis, and does not appear to compromise functional outcome.
authors.affiliation: Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California 94305, USA.
authors.forename: Allen S
authors.initials: AS
authors.lastname: Ho
authors.forename: Sanjay
authors.initials: S
authors.lastname: Morzaria
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Damrose
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D003679:Deglutition / Q000502:physiology; D006801:Humans; D007828:Laryngoscopy / Q000379:methods*; D054020:Lasers, Gas / Q000627:therapeutic use*; D007902:Length of Stay; D008875:Middle Aged; D010609:Pharyngeal Muscles / Q000601:surgery*; D011183:Postoperative Complications; D020545:Respiratory Mucosa / Q000601:surgery; D016896:Treatment Outcome